Role of trust in sustaining provision and uptake of maternal and child healthcare: Evidence from a national programme in Nigeria

作者：Nkoli Ezumah, Ana Manzano, Uchenna Ezenwaka, Uche Shalom Obi, Tim Ensor, Enyi Etiaba, Obinna Emmanuel Onwujekwe, Bassey Ebenso, Benjamin S C. Uzochukwu, Reinhard Huss, Tolib N Mirzoev · 发表于：Social Science & Medicine · 年份：2021 · DOI：10.1016/j.socscimed.2021.114644 · 被引用次数：33 · 研究领域：Global Maternal and Child Health、Healthcare Policy and Management、Primary Care and Health Outcomes

Despite increasing attention to implementation research in global health, evidence from low- and middle-income countries (LMICs) using realist evaluations, in understanding how complex health programmes work remains limited. This paper contributes to bridging this knowledge gap by reporting how, why and in what circumstances, the implementation and subsequent termination of a maternal and child health programme affected the trust of service users and healthcare providers in Nigeria. Key documents were reviewed, and initial programme theories of how context triggers mechanisms to produce intended and unintended outcomes were developed. These were tested, consolidated and refined through iterative cycles of data collection and analysis. Testing and validation of the trust theory utilized eight in-depth interviews with health workers, four focus group discussions with service users and a household survey of 713 pregnant women and analysed retroductively. The conceptual framework adopted Hurley's perspective on 'decision to trust' and Straten et al.'s framework on public trust and social capital theory. Incentives offered by the programme triggered confidence and satisfaction among service users, contributing to their trust in healthcare providers, increased service uptake, motivated healthcare providers to have a positive attitude to work, and facilitated their trust in the health system. Termination of the programme led to most service users' dissatisfaction, and distrust refle...